Access to prenatal records should be instantaneous

Minimal compliance with an antiquated American College of Obstetricians and Gynecologists (ACOG) guideline to send prenatal records at least once to the hospital by 36 weeks’ gestation is NOT “an excellent practice,” as suggested by Claudia Dobbs. Such a practice often means that our highest-risk patients—those 12% of births that are preterm—will likely be managed without any prenatal records, especially on nights and weekends. For the rest of our patients, this obsolete tradition leads to the commonplace scenario in which patients are managed with incomplete, outdated records—or none at all.

Risk managers and policy makers should insist that complete and up-to-date prenatal records be made available within seconds to clinicians in labor and delivery, 24 hours a day, 7 days a week, and at any gestational age.

Ms. Dobbs’ “helpful hint” and ACOG’s current guideline should no longer be condoned or even tolerated in 2007, when effective digital solutions exist that eliminate uninformed labor-and-delivery care forever.

Donald W. Miller Jr, MDShawnee, Kan

Ms. Dobbs responds: Only a few OBs can send records “within seconds”

I applaud Dr. Miller for promoting ideal communication between treating physicians to ensure safe patient care. His comments certainly demonstrate why physicians should seriously consider interoperable electronic medical records (EMRs). Unfortunately, his recommendations are feasible for only a small minority of physicians. Many of the obstetricians surveyed by my organization’s Loss Prevention Department report that they forward their prenatal records within the last trimester, as near to the estimated delivery date as possible. Very few doctors have EMRs and digitalized prenatal forms, and fewer still are interoperable with the local hospital’s EMR system, so their ability to send information digitally is limited. They certainly cannot forward their records “24 hours a day, 7 days a week” or make them available “within seconds,” especially on weekends or after hours.

To promote patient safety and decrease physician liability, I maintain that, if a treating obstetrician periodically forwards up-to-date copies of the patient’s prenatal records to the labor-and-delivery unit, the delivering obstetrician will have information available at the time of delivery. If the treating obstetrician discusses high-risk patients with his or her on-call colleagues and documents the discussions, the delivering physician will be informed and the treating obstetrican’s risk will therefore be reduced.

Preterm delivery is certainly a difficult matter. I really hope that the patient’s treating obstetrician is handling these cases personally and not relying on an on-call OB (nights, weekends) to do so without counsel.